by Omotayo Olatinwo, Yugandhara Devarapalli and M.D Gary Smith
Case Report
Invasive Saccharomyces cerevisiae infection is a rare and emerging fungal infection. The emergence of this invasive infection is due to the increased use of Saccharomyces boulardii probiotics. Saccharomyces boulardii probiotics are biotherapeutic agents used for the prevention and treatment of various diarrheal diseases. The benefits of these probiotics are well established; however, its associated infectious complications seem underestimated, especially in at-risk patients. Like other rare invasive yeast infections, invasive Saccharomyces infection has a high mortality rate. A 67-year-old man with multiple medical comorbidities and a complicated hospital course received Saccharomyces boulardii probiotics via percutaneous endoscopic gastrostomy tube for 22 days for Clostridium difficile prophylaxis treatment. We diagnosed him with invasive Saccharomyces cerevisiae fungemia resulting from Saccharomyces cerevisiae peritonitis. He developed multiple organ failure and shock, which led to his death 27 days after his first dose of Saccharomyces boulardii probiotics. To the best of our knowledge, we report the first case of invasive Saccharomyces cerevisiae fungemia due to Saccharomyces cerevisiae peritonitis caused by the combination of percutaneous endoscopic gastrostomy (PEG) tube placement and PEG tube administration of Saccharomyces boulardii probiotics in an at-risk hospitalized patient. Our goals for reporting this case are to heighten the index of clinical suspicion of invasive Saccharomyces fungemia, discuss the lessons we learned, and revisit the literature on the management of invasive Saccharomyces infection in at-risk hospitalized patients.
American Journal of Medical Case Reports. 2020, 8(3), 91-97. DOI: 10.12691/ajmcr-8-3-7
Pub. Date: January 27, 2020
4390 Views649 Downloads
by Jordan Carbono MS-IV, Gerry Samantha Eichelberger MS-III, Aman Kataria MS-IV, Zachary Field MD, Benjamin Kaplan MD, Federico Montalvo MD and Diana Salazar MD
Case Report
Necrotizing fasciitis is a considerably rare post-liposuction complication and E. coli and E. faecalis are exceedingly rare pathogens in a patient presenting with this life-threatening soft tissue infection. Although an uncommon liposuction complication, its prompt recognition is key, as it is a severe, insidiously advancing bacterial infection that can lead to high mortality if overlooked or misdiagnosed. A high index of clinical suspicion should prompt immediate treatment as imaging tools and lab markers can lead to rapid progression and are poorly specific for necrotizing fasciitis. We describe a case of a patient with post-liposuction necrotizing fasciitis associated with E. coli and E. faecalis, the first reported case in the literature. The patient presented with abdominal pain, fevers, and abdominal erythema with notable necrosis and bullae one day after surgery and underwent successful debridement and treatment with IV antibiotics. This case highlights a rare cause of necrotizing fasciitis and suggests the need for further study. In addition, it emphasizes the importance of cultures in necrotizing fasciitis cases and close follow-up in order to monitor bacterial organism prevalence, treatment options, and follow resistance patterns.
American Journal of Medical Case Reports. 2020, 8(3), 88-90. DOI: 10.12691/ajmcr-8-3-6
Pub. Date: January 25, 2020
4706 Views656 Downloads
by Samuel J. Apple, Benjamin Ramalanjaona, , Pramod Theetha Kariyanna and Isabel M. McFarlane
Case Report
Mitral valve aneurysm (MVA) is an ominous complication of infective endocarditis (IE), with worse outcomes seen among patients with preexisting valvular disease or intravenous drug use. Valve aneurysms can perforate or lead to rupture of the chordae tendineae, with the consequent development of severe mitral regurgitation and acute pulmonary edema. We present a case of a 54-year-old woman with hypertension, obesity, diabetes mellitus, hyperlipidemia, chronic obstructive pulmonary disease, peptic ulcer disease, obstructive sleep apnea, gastroesophageal reflux disease, intravenous drug abuse and bipolar disorder who developed MVA one month after being discharged for IE. Decline in the clinical status of patients with IE is a troubling sign that may indicate an IE complication such as MVA. Physicians should diligently monitor patients with IE for changes in signs and symptoms, as early recognition and surgical intervention are key to prevent further morbidity and mortality.
American Journal of Medical Case Reports. 2020, 8(3), 83-87. DOI: 10.12691/ajmcr-8-3-5
Pub. Date: January 19, 2020
5344 Views775 Downloads
by Krunal H. Patel, Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Nabila Khondakar, Madina Abduraimova and Samy I. McFarlane
Case Report
With the rise of the number of states fully legalizing marijuana, the use of this substance in the United States is at an all-time high. This increasing legalization gives the impression that marijuana is rather safe. However, multiple reports by our groups and others documented serious cardiovascular complications associated with marijuana use ranging from life threatening arrhythmia to myocarditis and myocardial infarction. In this report, we present a case of a 61 year old man presented with left sided typical chest pain shortly after marijuana consumption with the diagnosis of non ST-elevation myocardial infarction (NSTEMI) established based on clinical, EKG and troponin values with eventual cardiac catheterization documenting non-occlusive coronary artery disease with 30% obstruction of the proximal first obtuse marginal artery. We also review the putative pathophysiologic mechanisms of marijuana induced coronary vasospasms, highlighting the implications of these findings in the evaluation and management of cardiac chest pain in marijuana users.
American Journal of Medical Case Reports. 2020, 8(3), 79-82. DOI: 10.12691/ajmcr-8-3-4
Pub. Date: January 18, 2020
6386 Views948 Downloads
by Hira Chaudhary, Shweta Kumar, Nagasudha L Chigurupati, Gregory A. Chang, Gul Bahtiyar, Madina Abduraimova and Samy I. McFarlane
Case Report
Tacrolimus is a reversible calcineurin inhibitor. It is commonly used as an immunosuppressive drug in the treatment of T cell mediated diseases such as polymyositis, graft rejection in solid organ transplant, graft-versus-host disease in hematopoietic stem cell transplant, and is postulated to have diabetogenic potential. Fluconazole, on the other hand, is frequently prescribed antifungal therapy. Fluconazole increases the serum level of tacrolimus into the supratherapeutic range, thus developing drug toxicity if the dose is unadjusted. Diabetic ketoacidosis is a rare adverse drug effect reported with the use of tacrolimus. In this report, we present a case of DKA in a 60-year-old woman with polymyositis on low dose corticosteroids and tacrolimus, precipitated by the use of fluconazole. We highlight the pathophysiologic mechanisms underlying the effect of fluconazole on tacrolimus levels causing an accelerated development of DKA along with the review of literature on this potentially life-threatening condition.
American Journal of Medical Case Reports. 2020, 8(3), 76-78. DOI: 10.12691/ajmcr-8-3-3
Pub. Date: January 18, 2020
4565 Views832 Downloads1 Likes
by Justina Ray, Abdullah Mahmood, Muhammad Dogar, Junjing Guo, Felix Nwamaghinna, Louis Salciccioli and Samy I. McFarlane
Case Report
We present a case of simultaneous cardiotoxicity and stroke-like neurotoxicity in a patient treated with FOLFOX, a 5-Fluorouracil (5-FU)-containing chemotherapy regimen. Within hours of FOLFOX infusion, the patient began to exhibit signs and symptoms of myocardial ischemia and stroke mimic. Coronary vasoconstriction and vasospasm is a known mechanism of 5-FU-induced cardiotoxicity. 5-FU-induced neurotoxicity commonly presents as encephalopathy and is likely attributable to the accumulation of ammonia, a product of 5-FU metabolism. However, our patient presented with focal neurological signs and normal levels of ammonia. This suggests that 5-FU-induced vasospasm in the coronary arteries and cerebral vasculature is a likely cause of the simultaneous cardiac and neurological events we report here which have not been reported previously. Recognition of these toxicities as complications of 5-FU chemotherapy is crucial for the proper diagnosis and treatment of patients.
American Journal of Medical Case Reports. 2020, 8(3), 73-75. DOI: 10.12691/ajmcr-8-3-2
Pub. Date: January 17, 2020
4225 Views853 Downloads
by Ziad SayedAhmad, Zachary Oman, Ihab Hassanieh, ElSayed Abo-Salem and Tarek Helmy
Original Research
Atrial arrhythmias have been associated with a large number of medical conditions such as infection, chronic obstructive pulmonary disease, pulmonary embolism, hyperthyroidism, hypertension, and acute coronary syndrome to name a few. While less common, atrial arrhythmias have also been associated with disease processes causing pericardial inflammation. As such, presentation of atrial fibrillation/atrial flutter (A-Fib/A-Flutter) as a complication of pericardial effusion and the role of pericardiocentesis have not been well described. We report two cases of large pericardial effusions complicated by A-Fib/A-Flutter with immediate conversion to sinus rhythm following pericardiocentesis.
American Journal of Medical Case Reports. 2020, 8(3), 70-72. DOI: 10.12691/ajmcr-8-3-1
Pub. Date: January 16, 2020
5726 Views678 Downloads1 Likes